The Uncomfortable Truth About Brain Tonics

November 28th, 2016
By Jackie Larena-Lacayo

Nov 27, 2016 10:06 pm ET – The Wall Street Journal

There was a time in the 19th century when snake-oil remedies contained actual snake oil, and the real or imagined benefits for joint pain were widely touted. The problem, of course, was that snake oil and most other similar tonics, concoctions and liniments had secret and wholly ineffective ingredients and, aside from perhaps offering a placebo effect, mainly benefited the pocketbook of the purveyor.

So with the current panic about dementia among middle age and older individuals and the resultant explosion of various brain tonics on the market, do we have any more evidence today to believe in the efficacy of these products, or are they no different from the snake oils of days’ past? As a geriatric psychiatrist and director of a memory disorders center, I often get questions about these tonics and their claims.

Here, then, is a primer to evaluating both the need and the potential benefits, if any, of the many products on the market.

Brain tonics are pills or liquids sold as dietary supplements promoted to preserve or boost memory and other cognitive functions. Most of these tonics contain combinations of ingredients including vitamins, minerals, herbs, amino acids and other synthetic or natural extracts. People take them not only in hope of improving cognition but also to reduce the risk of developing a cognitive disorder or to treat an existing disorder.

As supplements they do not require approval by the Food and Drug Administration, and so the bar for proving their effectiveness is quite low. In contrast, the several FDA-approved medications for Alzheimer’s disease had to demonstrate extensive scientific evidence of safety and efficacy and must adhere to strict marketing guidelines.

The first question one should know before considering a brain tonic is whether he or she truly has a memory problem. Subjective complaints about memory and other cognitive deficits may not have any objective basis, and so neuropsychological testing would be needed to even demonstrate actual deficits. When present, these complaints often reflect either normal age-associated changes or mild impairment due to one or more transient causes, including menopause, medication effects, stress, anxiety, depression, substance use, sleep problems and attentional deficits, to name just a few.

In these situations, the only true brain boost is to address the underlying causes. Making an actual diagnosis of a cognitive disorder such as Alzheimer’s disease requires in-depth evaluation, and most people shopping for a tonic have not had any prior, meaningful assessment.

This same lack of diagnostic clarity can be found in the few studies cited by the most popular brain tonics, as they include subjects with amorphous “memory problems” but no true diagnoses. As a result, the data is almost always based on a small set of subjects with various unknown conditions, and is not rigorous enough to make firm conclusions or to garner publication in a mainstream peer-reviewed scientific journal.

The most compelling scientific data would have to come from a randomized, double-blind, placebo-controlled study of a large group of individuals with a confirmed cognitive disorder. But even when such studies have been conducted, no brain-boosting substance has ever consistently shown significant benefit on memory or other cognitive abilities.

This includes substances such as gingko biloba and omega-3 fatty acids. The largest and most rigorous studies ever conducted looked at vitamin E (in combination with an FDA approved medication for Alzheimer’s disease) but it did not demonstrate the ability to prevent development of dementia and only showed a slight slowing in functional decline in individuals already diagnosed with Alzheimer’s disease. That’s hardly adequate guidance for people with minor memory complaints wanting to load up on vitamins.

An exploration of various brain-tonic ingredients yields several more caveats. Vitamin deficiencies involving B12, thiamine or folate are rare causes of cognitive problems, and supplementation above normal blood levels will make no difference. The same limitations apply to vitamins C and D. Other supplements, with curcumin being a good example, barely make it into the bloodstream after being ingested and might not even cross the special cellular barrier that guards our brains. Other supplements are touted as building blocks for brain cells, but while that may be beneficial in the diet for normal brain functioning, there is no significant evidence that such supplements actually improve brain function above and beyond normal, nor that they specifically lower the risk of getting Alzheimer’s disease.

To actually show that a brain tonic works, extensive and expensive scientific studies would be needed, but this approach is typically too taxing and risky for the finances and interest of nearly every producer. Consider this fact: In the past 15 years, major pharmaceutical companies have invested hundreds of millions of dollars on rigorous scientific studies for dozens of experimental agents to treat Alzheimer’s disease, and yet 99% of these studies have failed.

It is a tough goal to find such an elixir for a better brain–one that continues to elude the very best of scientific inquiry. A more viable solution for optimizing brain health according to scientific research is regular, moderate exercise, mentally and socially stimulating activities, and a diet similar to the Mediterranean diet loaded with fruits and vegetables, whole grains, healthy oils and even a daily glass of wine.

While it would be wonderful to compress this lifestyle into a single pill or potion, the search for a truly effective brain tonic continues.

Marc Agronin, M.D., is a geriatric psychiatrist at Miami Jewish Health in Miami, Florida and the author of “How We Age” and “The Dementia Caregiver: A Guide to Caring for Someone with Alzheimer’s Disease and Other Neurocognitive Disorders.”